Is the Health Care System Working for Adolescents? Perspectives From Providers in Boston, Denver, Houston, and San Francisco

Assesses healthcare system services for adolescents in four urban areas. Includes provider perspectives on how health insurance, managed care, and other factors facilitate or impede access. Discusses innovative programs, and offers recommendations

A model balancing cooperation and competition explains our right-handed world and the dominance of left-handed athletes

An overwhelming majority of humans are right-handed. Numerous explanations for individual handedness have been proposed, but this population-level handedness remains puzzling. Here we use a minimal mathematical model to explain this population-level hand preference as an evolved balance between cooperative and competitive pressures in human evolutionary history. We use selection of elite athletes as a test-bed for our evolutionary model and account for the surprising distribution of handedness in many professional sports. Our model predicts strong lateralization in social species with limited combative interaction, and elucidates the rarity of compelling evidence for "pawedness" in the animal world.Comment: 5 pages of text and 3 figures in manuscript, 8 pages of text and two figures in supplementary materia

A hazard model of the probability of medical school dropout in the United Kingdom

From individual level longitudinal data for two entire cohorts of medical students in UK universities, we use multilevel models to analyse the probability that an individual student will drop out of medical school. We find that academic preparedness—both in terms of previous subjects studied and levels of attainment therein—is the major influence on withdrawal by medical students. Additionally, males and more mature students are more likely to withdraw than females or younger students respectively. We find evidence that the factors influencing the decision to transfer course differ from those affecting the decision to drop out for other reasons

Would changing the selection process for GP trainees stem the workforce crisis? A cohort study using multiple-imputation and simulation

BACKGROUND: There is currently a shortage of qualified GPs in the UK and not all of the training posts available each year are filled. Changing the way in which GP trainees are selected could help increase the training post fill rate and the number of new entrants to the GP Register. The aim of this study was to model the impact of changing the selection process for GP training on the number of trainees obtaining GP Registration, either with or without extensions. METHOD: This was a cohort study using UK applications for GP training in 2011-14. Application data were linked using GMC numbers to training outcome data where available, and imputed using multiple imputation where missing. The number of trainees appointed and GP Registrations within three and five years' full-time-equivalent were estimated for four different selection processes. RESULTS: The cut scores used in the actual 2015 selection process makes it impossible to fill all training posts. Random selection is the worst option, but the difference between this and other processes modelled falls as more trainees are selected. There are large marginal effects on outcomes: those with the highest selection scores are more likely to obtain GP Registration than those with the lowest scores. CONCLUSIONS: Changing the selection process alone would have a small impact on the number of GP Registrations; reducing/removing cut scores would have a much larger impact. This would also increase the number of trainees requiring extensions and being released from training which would have adverse consequences for the profession

Meta-analytic findings reveal lower means but higher variances in visuospatial ability in dyslexia

Conflicting empirical and theoretical accounts suggest that dyslexia is associated with either average, enhanced, or impoverished high-level visuospatial processing relative to controls. Such heterogeneous results could be due to the presence of wider variability in dyslexic samples, which is unlikely to be identified at the single study level, due to lack of power. To address this, the current study reports a meta-analysis of means and variances in high-level visuospatial ability in 909 non-dyslexic and 956 dyslexic individuals. The findings suggest that dyslexia is associated not only with a lower mean performance on visuospatial tasks, but also with greater variability in performance. Through novel meta-analytic techniques, we demonstrate a negative effect size for mean differences (-.457), but a positive effect size for SD differences (+.118; SD ratio = 1.107). In doing so, this is the first study to demonstrate impoverished visuospatial processing of the majority of individuals with dyslexia in addition to greater variance in performance in this group. The findings advocate for further consideration of both the presence of, and reasons for, increased variance in perception, attention and memory across neurodevelopmental disorders

Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review

Background: Alongside specialist cancer clinics, general practitioners have an important role in cancer patients’ follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature. Methods: Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside specialist care were reviewed. Results: A total of 19 papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions. Conclusion: Involving general practitioners in post-treatment cancer care is beneficial to patients. However, proactive initiatives that encourage and facilitate patients to consult their general practitioner about their needs or symptoms of recurrence should be considered

Investigating possible ethnicity and sex bias in clinical examiners: an analysis of data from the MRCP(UK) PACES and nPACES examinations

Bias of clinical examiners against some types of candidate, based on characteristics such as sex or ethnicity, would represent a threat to the validity of an examination, since sex or ethnicity are 'construct-irrelevant' characteristics. In this paper we report a novel method for assessing sex and ethnic bias in over 2000 examiners who had taken part in the PACES and nPACES (new PACES) examinations of the MRCP(UK)

Graves, Gifts, and the Bereaved Consumer: A Restorative Perspective of Gift Exchange

When a gifting relationship is disrupted by death, why might a living consumer continue to invest in it? Consumer spending on deceased loved ones does not end with the funeral. Given the embodying power of a physical gravesite, this article examines the practice of gift giving to the deceased in the context of American cemeteries. We employ a longitudinal approach, in which 180 cemetery gravesites were photographed. The photographic data are coupled with a netnography of grief and bereavement communities. Findings support a restorative perspective of gift exchange. Bereaved consumers utilize restorative giving as a mechanism to cope with loss and maintain relationships with deceased loved ones. We outline five categories of gifts given to the deceased and present a framework of restorative giving practices. Implications are discussed in terms of identity development, symbolic communication, and reciprocity in gift giving, as deceased consumers continue to be recipients of tangible goods

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

Objective To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance

231Pa/230Th evidence for a weakened but persistent Atlantic meridional overturning circulation during Heinrich Stadial 1

The strength of Atlantic meridional overturning circulation is believed to affect the climate over glacial-interglacial and millennial timescales. The marine sedimentary ²³¹Pa/²³⁰Th ratio is a promising paleocirculation proxy, but local particle effects may bias individual reconstructions. Here we present new Atlantic sedimentary ²³¹Pa/²³⁰Th data from the Holocene, the last glacial maximum and Heinrich Stadial 1, a period of abrupt cooling ca. 17,500 years ago. We combine our results with published data from these intervals to create a spatially distributed sedimentary ²³¹Pa/²³⁰Th database. The data reveal a net ²³¹Pa deficit during each period, consistent with persistent ²³¹Pa export. In highly resolved cores, Heinrich ²³¹Pa/²³⁰Th ratios exceed glacial ratios at nearly all depths, indicating a significant reduction, although not cessation, of overturning during Heinrich Stadial 1. These results support the inference that weakened overturning was a driver of Heinrich cooling, while suggesting that abrupt climate oscillations do not necessarily require a complete shutdown of overturning